Affordable Care Act (Obamacare)

Below you will find resources that can help you understand the Affordable Care Act (ACA, also known as Obamacare) and how it improves healthcare for people living with HIV/AIDS. We will update this page as more information is released.

If you have a question about the ACA and HIV/AIDS after reviewing these resources, let us know by contacting your NAP Case Manager or emailing us with general questions at ACA@nap.org. We will do our best to help you find an answer!

What is the Affordable Care Act? How does the ACA help people living with HIV/AIDS?

The Patient Protection and Affordable Care Act (ACA) was developed to achieve better health outcomes in the United States by increasing the number of insured Americans, reducing care costs, and improving the overall American health care system. To achieve that, major changes are under way in both the health insurance marketplace (eg, reforms in insurance laws, expansion of Medicaid eligibility) and the health care delivery system (eg, through investigation of new ways to fund and deliver care).

The ACA has a number of positive effects for people living with HIV/AIDS:

Private insurance companies can no longer deny coverage to HIV-positive people – no more pre-existing condition clauses

Private insurance can no longer charge unreasonably high rates simply because someone is HIV positive

Provides subsidies to low and middle income HIV positive people to purchase private insurance

Closes the Medicare Part D “donut hole” making medications more affordable

Learn more about the ACA and the Health Insurance Marketplace at HealthCare.gov. There you can sign up for updates and access more information.

I live with HIV, how do I access insurance?

There are two ways for you to access insurance: 1) through your employer, or 2) through the ACA Individual Marketplace (also referred to as the Exchange). If you are a NAP client or access ADAP, you may be eligible for additional assistance to help pay for insurance. Contact your case manager, they can help you make sense of the best plans for you and find out if you qualify for assistance! Again, HealthCare.gov is a great resource for all your enrollment needs.

I already have insurance through my employer. Do I need to do anything different?

Great question! Hopefully not! If you’re happy with your insurance and it is affordable, you don’t need to change anything. However, If you’re employer provided insurance is unaffordable (the cost to you is greater than 9.5% of your household income), you would be eligible to shop for more affordable insurance in the Marketplace. In that case, get chatting with your employer’s Human Resources department for more information.

What happens if I lose insurance coverage through my employer? (I just lost my employer coverage, what happens?)

If you lose your employer coverage, you have options:

Option 1 would be to access COBRA from your employer. But we all know COBRA is not the most affordable thing, so…

Option 2 would be to access insurance through the ACA Marketplace. Loss of employment and employer insurance coverage counts as a “special enrollment event” and you can purchase insurance through the Marketplace

If you’re a NAP client, please let your Case Manager know of any changes in your employment situation so we can help you navigate the situation.

I already access care through Medicare and/or Medicaid. Do I need to apply for Marketplace Insurance?

Nope. You are good to go. The ACA doesn’t change your Medicare or Medicaid, and youdo not need Marketplace Insurance.

What if I don’t know if I am eligible for Medicare or Medicaid?

That’s easy. If you are age 65 or older, worked 10 years or more in Medicare covered employment (i.e. paid FICA taxes), and are a U.S. citizen or legal resident – you are eligible for Medicare. Check out this Medicare eligibility tool to find out. If you’re unsure about Medicaid eligibility, no worries, the Marketplace portal (www.healthcare.gov) will screen you for Medicaid eligibility and other public assistance programs.

How do I know if I am eligible for a tax credit to help pay for ACAMarketplace Insurance?

If your household income falls between 101% and 400% of the federal poverty line, you qualify for a premium tax credit to help pay for your Marketplace Insurance. Additionally, if your income falls between 101% and 250% of the federal poverty line, you qualify for additional cost sharing assistance. To find out your household income in relation to the federal poverty line, use this tool provided by the Kaiser Family Foundation. It will also show you what kind of assistance will be available to you: http://kff.org/interactive/subsidy-calculator/

What about Medicaid Expansion?

Nebraska chose not to participate in Medicaid Expansion. So, if you live in Nebraska there is no expanded Medicaid eligibility for non-disabled persons living with HIV. This must change. Check out our Advocacy Tools page for more information. Updates on Medicaid Expansion advocacy will be arriving soon! If you live in Iowa, you are in luck. Iowa did expand Medicaid to non-disabled persons living with HIV. Contact your NAP Iowa Case Manager to see if you qualify.

Stay tuned for more updates! If you were unable to find an answer to your question on this page or the linked resources, please get in touch with your NAP Case Manager (if you are a client) or you can email ACA@nap.org for general information requests.